Therapeutic Recreation Internship Site Application

Thank you for your interest in offering a therapeutic recreation internship for our future recreation professionals. This is the culminating educational experience for our students, and the Department of Recreation, Parks, & Leisure Services Administration at Central Michigan University appreciates your desire to provide an internship opportunity.

Please fill out the complete form below, and click the "Submit" button to send to RPL. If you would prefer to fill out the form offline, you can download the PDF version and send it via postal mail to our department.

Basic Information - Required for this formIndicates Required Fields

Facility Name:Required for this form
Affiliate:
Department:
Address:  Required for this form
City:Required for this form State:Required for this form   Zip:  Required for this form
Phone:Required for this form
Fax:
Email:Required for this form
Web Site:
Contact Person:Required for this form
(name/title)

About your facility & internship opportunities (all sections required)

Populations served at your facility (check all that apply)

Physically Disabled Geriatrics Chemically Dependant
Psychiatric Mentally Impaired Legal Offenders
Traumatic Brain Injuries    

Setting (check all that apply)

Clinical / Rehabilitation Day Treatment Camp
Inpatient Institution High Adventure
Outpatient Corrections Community
Other    

Age Groups Served (check all that apply)

Children Adolescents Adults Senior Citizens

Goals Required to Attain During Internship (check all goals you can provide for a student intern)
(hover mouse pointer over items for expanded descriptions)

Provide orientation to staff and facilities Intern is fully responsible for implementing a project/program
Entry level capacity advancing to professional tasks Involvement in community activities
Involvement/experience in practical politics of facility Knows client motivation, discipline, & behavior mgmt w/ clients
Involvement in individual/group client planning Knowledge of recreational department policies and procedures
Knowledge of treatment/intervention philosophy of facility Involvement in administrative procedures
Involvement in client record-keeping & recording. Knowledge of resources to service clients
Involvement with ongoing recreation programming Role of drugs/medication in client treatment
Plan & facilitate 1+ program, presentation, or event Involvement in participant registration and scheduling
Involvement in team/interdisciplinary functions Involvement in negotiation of programming barriers
Awareness of revenue sources, budgets, & legislation Demonstrate skills in departmental public relations
Involvement in special recreation programming Knows referral/follow-up procedures toward client independence
Ability to work with advisory boards or commissions Other:

List names of staff members presently NCTRC certified: (include yourself, if applicable)

Brief Description of Internship Responsibilities:

Qualifications/Skills Required of an Intern for placement at your facility:

Compensation
Salary     (if checked, how much?)  $ per hour   week    month
Housing
Other Compensation:

Internship Placement Time Frame Acceptable to Facility (check all that apply)
Year-round     Fall/Winter    Spring    Summer

Length of Internship:
30 Weeks (2 semesters)    15 Weeks (1 semester)    Other (describe:)

Additional Comments:

Note: If you'd like a copy of this information for your records, please print this page before clicking the submit button below.

CMU, an AA/EO institution, strongly and actively strives to increase diversity within its community.
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